J Nutr Sci Vitaminol, 66, S398–S405, 2020

Poor Dietary Diversity Is Associated with Stunting among

Children 6–23 Months in Area of Mergangsan Public
Health Center, Yogyakarta

Hildagardis Meliyani Erista Nai1 and Brigitte Sarah Renyoet2

1
School of Health Sciences Panti Rapih, Tantular Street No.401, Pringwulung, Condongcatur, Depok,
Sleman, Special Region of Yogyakarta, Indonesia 55283
2
Departement of Nutrition, Faculty of Medicine and Health Sciences Satya Wacana Christian University,
Kartini Street No.11A, Salatiga, Central Java, Indonesia
(Received, June 24, 2019)

Summary The period of pregnancy and the first two years of children are called the
golden period so that the adequacy intake of macro and micronutrients must be fulfilled.
Stunting is a chronic undernutrition condition as a result of inadequate quality and quan-
tity of complementary foods with or without infectious diseases. Quality and quantity of
complementary foods can affect linear growth. To analyzed the association between dietary
diversity and stunting among children aged 6–23 mo in the area of Mergangsan public
health center, Yogyakarta. Method: Study was an analytic observational study with a
cross-sectional design. The population was children aged 6–23 mo from 60 integrated
health service centers in the area of Mergangsan public health center with a total popula-
tion of 343 children. The sample size was 135 children. Samples were selected using simple
random sampling. Data were analyzed using univariate (descriptive), bivariate (chi-square
test), and multivariate analysis (multiple logistic regression). The result of bivariate analysis
showed that there was a significant association between dietary diversity of complementary
foods (p5​0.012; RP5​2.87; CI: 1.23–6.68) and father’s height (p5​0.03; RP5​2.58; CI:
1.06–6.30) with stunting. The result of the multivariate analysis showed that there was a
significant association between dietary diversity of complementary foods and stunting
while there was no association between the father’s height and stunting. Poor dietary diver-
sity of complementary foods was a risk factor of stunting among children aged 6–23 mo.
Key Words minimum dietary diversity, minimum meal frequency, complementary foods,
stunting, children

Stunting describes a condition of growth failure in mentary feeding prepared by the family must pay atten-
terms of length or height indicated by the value of tion to the diversity and portion of complementary food
z-scores for length-for-age (LAZ) or height-for-age (HAZ) to meet child’s nutritional requirements (2, 8). Previous
below 22 standard deviation (22SD) from the World study found that there was a significant relationship
Health Organization (WHO) growth chart as a result of between dietary diversity and stunting (9–11).
poor health and insufficient energy and nutrient intake Prevalence of stunting in children under 5 y has
during in the womb and continue until the first of 2 y decreased during the past two decades, but it is higher
(1–3). Stunting increased morbidity and mortality, ele- in Asia and Africa than elsewhere and globally affected
vated risk of metabolic disease, decreased learning abil- at least 165 million children in 2011 (12–14). Preva-
ity and economic capacity into adulthood (1, 3, 4). lence of stunting in Indonesia in 2013 was 37.2% (15).
Inadequate dietary intake is one of the immediate Based on the results of Nutritional Assessment in 2017,
causes of stunting in children other than infectious dis- the prevalence of stunting in children under-five-years
eases (1, 3). Complementary food is a source of macro- in Special Region of Yogyakarta is 19.8%. The preva-
nutrient and micronutrient intake for children aged lence of stunting among children under-five-years in
6–23 mo besides breast milk. Children can experience each district being 23.65% in Kulon Progo District,
failure to grow during the period of complementary 22.9% in Bantul District, 27.9% in Gunung Kidul Dis-
feeding administration if the quantity and quality of trict, 10.6% in Sleman District, and 23% in Yogyakarta
complementary food are low. The low quantity and City (16). The results of the assessment of nutritional
quality of complementary food cause children to experi- status in August 2017 in Yogyakarta City showed the
ence deficiencies of macronutrients and micronutrients prevalence of stunting children in 14 public health cen-
that play an essential role on child’s growth and devel- tres in the Yogyakarta City area. Mergangsan Public
opment (2, 5–7). Therefore, the provision of comple- Health Center has the highest prevalence of stunting in
children under-five-years by 20.55% (17).
E-mail: [email protected] Considering the prevalence of stunting more than

S398
 Poor Dietary Diversity and Stunting S399

20.0% so that stunting is a public health problem in the study, dietary diversity was defined as the consumption
region, stunting impacts, and the importance of com- of minimum dietary diversity and minimum meal fre-
plementary food to meet children’s nutrients adequacy quency. It means the present study measured the diver-
during periods of rapid growth and development, the sity of complementary food by taking into the quality
present study was conducted with objective to analyze and quantity of daily consumption of complementary
the relationship between dietary diversity of comple- food. It based on one of messages of Balanced Nutrition
mentary food and the incidence of stunting in children Guidelines (Pedoman Gizi Seimbang) for infants and
aged 6–23 mo in the working area of the ​​ Mergangsan children aged 6–24 mo (2).
Public Health Center. Minimum dietary diversity and minimum meal fre-
quency are defined using the recommended WHO
MATERIALS AND METHODS
infant and young child feeding (IYCF) indicators. Mini-
Design, place and time. This study was an analytic mum dietary diversity indicator is the proportion of
observational study with cross-sectional design. The children 6–23 mo of age who receive foods from 4 or
study was conducted in the working area of Mergang- more food groups from a total of 7 food groups name-
san Public Health Center, Yogyakarta City from March ly-grains, roots & tubers; legumes & nuts; dairy prod-
2018 to October 2018. ucts; meat/fish/seafood; eggs; vitamin A rich fruits &
Population, sample size calculation and sampling tech- vegetables; other fruits & vegetables. Minimum meal fre-
nique. The source population was children aged quency indicator is the proportion of breastfed and
6–23 mo who came to 60 integrated health post non-breastfed children 6–23 mo of age who receive
(Posyandu) in the Mergangsan Public Health Center solid, semi-solid, or soft foods (but also including milk
working area. Posyandu is an integrated service post feeds for non-breastfed children) the minimum number
which is one form of Community-based Health Efforts of times or more. For breastfed children, the minimum
(UKBM) in Indonesia that is managed and organized number of times varies with age (2 times if 6–8 mo and
from, by, for and with the community in the implemen- 3 times if 9–23 mo). For non-breastfed children the
tation of health development, to empower the commu- minimum number of times does not vary by age (4
nity and provide facilities to the community in obtain- times for all children 6–23 mo) (20). Dietary diversity is
ing basic health services, especially to accelerate the categorized as diverse if children consumed the mini-
reduction of maternal and infant mortality (18). mum dietary diversity and minimum meal frequency
A total populations of children aged 6–23 mo in and not-diverse if not consumed minimum dietary
August Posyandu period was 343 children. A required diversity and or minimum meal frequency.
sample size of 135 children was estimated by using Covariates is known as risk factors for child stunting.
hypothesis testing of relative risk formula. The preva- These variables was considered as counfounding factors
lence of stunting proportion based on previous study (potential confounders). They included child’s sex,
(19) considering a power of 80%, a significance level of child’age, parents’ employments and education level,
0.05, and a relative risk (RR) considered clinically sig- family income, household members, breastfeeding sta-
nificant of 1.9. Of 343 children, there were 41 children tus, child past illness (infectious diseases), parents’
who stunted. All of them were taken as subject and height, and child’s birth weight. The cut-off points of
children who not-stunted were selected by simple ran- parents’ height were 162 cm (21) and 150 cm (19) for
dom sampling. children’s father and mother respectively. Low birth-
Subjects of study. The subjects were children aged weight is defined as weight at birth of less than
6–23 mo with their mothers as respondent. If mothers 2,500 grams (22).
were not available because of working outside, other Data collection. Types of data are primary and sec-
caregivers were enrolled. Inclusion criteria were as fol- ondary derived from the results of measuring of the
lows: lives for at least 6 mo in the study area, respon- child’s length in the Posyandus by enumerators and
dents were willing to sign an informed consent, older health volunteers (cadres) and interviewing respon-
children if in one family there were more than one child dents by enumerators. Data collection was carried out
aged between 6–23 mo, and children were not physi- by researchers with 6 enumerators, namely students of
cally disabled (paralyzed). Exclusion criteria as follows: the Bachelor of Nutrition Study Program School of
children who had severe acute malnutrion, mothers Health Sciences Panti Rapih Yogyakarta. The enumera-
were not able to respond the interviews, one of the chil- tors have received training in using household ques-
dren’s parents or both of them has passed away. tionnaire and Food Frequency Questionnaire and mea-
Outcome, exposure, and confounding factors (covariates). suring length and height.
Stunting was the main outcome of the study. Stunting The household questionnaire was adapted from the
was assed by calculating an age and gender adjusted validated quetionairre. It consists of questions on the
with z-score for length-for-age (LAZ) of each child sociodemographic characteristics of mother and child,
according to the WHO (2006) child growth standards. household characteristics, breastfeeding and comple-
Child was categorized as stunted if z-score ,22 stan- mentary feeding practices, birth weight, and child’s past
dard deviation and not stunted if z score $22 standard illness. Sociodemographic characteristics included
deviation. child’s age and sex, education and employment of par-
The main exposure was dietary diversity. In this ents. Parents’ education levels were categorized as high
S400 Nai HME and Renyoet BS

if children’s mother and father had completed a mini- Table 1. Distribution of subject’s characteristics.
mum education of senior high school and as low if they
completed junior high school or lower. Household char- Characteristics of subject Frequency Percentage (%)
acteristics included household size and income cate-
gory. Household income based on regional minimum Child’s sex
Male 74 54.8
wage of Yogyakarta City. Family income categorized as
Female 61 45.2
high if it was Rp 1.709.150 or more and low if less
Child’s age (months)
than Rp1.709.150. Birth weight were obtained from 6–12 49 36.3
mothers recall or “Buku KIA”. Child illness included the 13–23 86 63.7
presence of fever, diarrhea, cough, and flu, pneumonia Mother’s education level
in the previous 2 wk until the day before the interview. Low 16 11.9
The Food Frequency Questionaire (FFQ) was used to High 119 88.1
record information regarding minimum dietary diver- Father’s education level
sity and minimum meal frequency in the previous 3 mo Low 14 10.4
period (3 mo can describe the usual diet of child) which High 121 89.6
Employment status of the mother
included the type of food items of the each food groups
Working 59 43.7
and the number of times they had consumed meal. Non-working 76 56.3
Dietary diversity score is obtained by summing the Family income
food groups consumed a day from the seven types of Low(,Rp 1.709.150) 54 40.0
food groups. Interval of dietary diversity score starts High ($Rp 1.709.150) 81 60.0
with a minimum of 0 if no food group is consumed up Household family size
to 7 if all food groups are consumed. Consumption of .4 53 39.3
each food group was defined as “yes” when the child #4 82 60.7
had consumed at least one food item within the food Continued Breast feeding
group and “no” when the child had not consumed any No 34 25.2
food item within the food group (20). Frequency of con- Yes 101 74.8
Child illness in the past 2 wk
sumption of each food item within one food group is
Yes 55 40.7
converted in a day (for example, consumption of eggs 1 No 80 59.3
time per day is equal to daily consumption, consump- Mother’s height
tion of eggs and meat 6 times per week converted for a Low (,150 cm) 16 11.9
day to 0.85 (6:7); consumed eggs and meat 10 time in a Normal ($150 cm) 119 88.1
month converted for a day to 0.33 (10:30), consumed Father’s height
eggs and meat 12 times converted for a day to 0.13 Low (,162 cm) 25 18.5
(12:90). Considering daily consumption if the sum fre- Normal ($162 cm) 110 81.5
quency of food items within food group was equal to 1 Birth Weight
or more. Low (,2,500 g) 13 9.6
The minimum meal frequency was estimated by Normal ($2,500 g) 122 90.4
using household questionnairre and rechecked by using
FFQ. Mothers of children were requested to count their Total 135 100.0%
children’s meal frequency in one day.
Anthropometric measures of children and their par-
ents were recorded. The length of children was mea-
sured in lying down position using a infantometer and in the bivariate analysis using the multiple logistic
was recorded to the nearest 0.1 cm. The height of par- regression test. The final logistic regression model was
ents was measured in the standing position without determined through stepwise backward selection. For
shoes to the nearest 0.1 cm using a microtoise (when all the analyses, p-value ,0.05 indicated statistical sig-
there were a condition that did not allow direct mea- nificance in two-sided test. Data analysis used the SPSS
surement, the height of parents was obtained by asking version 21.
the respondents). Length-for-age was calculated accord- Ethical approval. Permission to collect data in work
ing to the WHO standard reference 2006. The length- area of Mergangsan Public Health Center was obtained
for-age indicator was expressed as z score. from local authorities. They are National Unity and Pol-
Data processing and analysis. Data analysis used uni- itics Office Yogyakarta, Yogyakarta City Health Service
variate analysis, bivariate analysis, and multivariate Office, Investment Service and Permission Office Yogya-
analysis. Univariate analysis is carried out to describe karta, and Mergangsan Public Health Center. Enumera-
the research variables in frequency and percentage. tor explained the research objectives and requested
Bivariate analysis was conducted to examine the asso- respondents to sign an informed consent form before
coation of exposure and outcome using the chi-square begining the interview and taking anthropometri mea-
test. Multivariate analysis was carried out to analyze surements.
the association of independent and dependent variables
by controlling for covariates that had a p-value ,0.25
 Poor Dietary Diversity and Stunting S401

Table 2. Bivariate analysis of factors associated with stunting in children aged 6–23 mo.

Stunted (n541) Non-stunted (n594)

RP**
Characteristics of subject p-value
(95%CI)
f % f %

Child’s sex
Male 27 36.5 47 63.5 0.09 1.93
Female 14 23.0 47 77.0 (0.90–4.31)
Child’s age (months)
6–12 15 30.6 34 69.4 0.96 1.02
13–23 26 30.2 60 69.8 (0.48–2.18
Mother’s education level
Low 7 43.7 9 56.3 0.21 1.94
High 34 28.6 85 71.4 (0.67–5.64)
Father’s education level
Low 4 28.6 10 71.4 0.88 0.91
High 37 30.6 84 69.4 (0.27–3.08)
Employment status of the
mother
Working 16 27.1 43 72.9 0.47 0.76
Non-working 25 32.9 51 67.1 (0.36–1.60)
Family income
Low(,Rp 1.709.150) 17 31.5 37 68.5 0.90 1.09
High ($Rp 1.709.150) 24 29.6 57 70.4 (0.52–2.30)
Household family size
.4 15 28.3 38 71.7 0.67 0.85
#4 26 31.7 56 68.3 (0.40–1.81)
Continued Breastfeeding
No 11 32.4 23 67.6 0.77 1.33
Yes 30 29.7 71 70.3 (0.49–2.61)
Child illness in the past 2 wk
Yes 19 34.6 36 65.4 0.77 1.13
No 22 27.5 58 72.5 (0.49–2.61)
Mother’s height
Low (,150 cm) 7 43.8 9 56.2 0.21 1.94
Normal ($150 cm) 34 28.6 85 71.4 (0.67–5.64)
Father’s height
Low (,162 cm) 12 48.0 13 52.0 0.03* 2.58*
Normal ($162 cm) 29 26.4 81 73.6 (1.06–6.30)
Birth Weight
Low (,2,500 g) 6 46.2 7 53.8 0.19 2.13
Normal ($2,500 g) 35 28.7 87 71.3 (0.67–6.79)

* Significant (p,0,05); ** RP5Ratio prevalence.

than 70.0% of children were still breastfeeding. The

RESULTS
majority of subjects had not illness in the past 2 wk
Characteristics of subjects until the day before the interview. Most of children had
A total of 135 children aged 6–23 mo and their mothers and fathers with normal height (88.1% and
mothers participated in the study. There were 41 81.5%, respectively) and normal birth weight (90.4%).
(30.37%) children who were stunted and 94 (69.63%) Table 2 shows association between subject character-
not stunted. Characteristics of the subjects are shown istics and stunting. The charactersitics was considered
in Table 1. Mean and standard deviation of length-for- as determinants factor of stunting. This study found
age z-score (LAZ) for all children were 21.016​1.83. that there were not association between child’s sex,
Based on Table 1, most of the subjects were male child’s age, parents’ education level, employment status
(54.8%) and belonged to 13–23 mo age group (63.7%). of mother, family income, household family size, child’s
Both mother and father education level were high illness, mother’s height, and child’s birth weight with
(88.1% and 89.6%, respectively). More than 50.0% of stunting (p.0.05), whereas there was a significant
children mothers were non-working mothers. Most of association between father’s height and stunting in
children came from families with high income (60.0%) children aged 6–23 mo (p,​0.05). Children who had
and had less than 4 family members (60.7%). More shorter father (,162 cm) were more likely to be stunted
S402 Nai HME and Renyoet BS

Table 3. The differences of food group consumption between stunted and non-stunted children.

Stunted (n541) Non-stunted (n594)

Consumption of Food Group p-value
f % f %

Grains, roots & tubers

No 2 66.7 1 33.3 0.17
Yes 39 29.6 93 70.4
Meat/fish/seafood
No 27 37.5 45 62.5 0.54
Yes 14 22.2 49 77.8
Egg
No 36 34 70 66 0.08
Yes 5 17.2 24 82.8
Legumes & nuts
No 22 33.8 43 66.2 0.40
Yes 19 27.1 51 72.9
Fruits and vegetables rich in vitamin A
No 7 33.3 14 66.7 0.75
Yes 34 29.8 80 70.2
Other Fruits and vegetable
No 34 36.6 59 63.4 0.02*
Yes 7 16.7 35 83.3
Dairy products
No 22 30.6 50 69.4 0.96
Yes 19 30.2 44 69.8

* Significant (p,0.05).

Table 4. Bivariate analysis of the association between child feeding indicators and stunting in children aged 6–23 mo.

Non-stunted
Stunted (n541) Total
(n594) RP**
Child Feeding Indicators p
(95%CI)
f % f % f %

Minimum Dietary Diversity:

Inadequate 25 43.9 32 56.1 57 100.0 0.04 3.03 (1.42–6.47)
Adequate 16 20.5 62 79.5 78 100.0
Minimum Meal Frequency:
Inadequate 14 34.1 27 65.9 41 100.0 0.53 1.29 (0.59–2.82)
Adequate 27 28.7 67 71.3 94 100.0

* Significant (p,0,05), ** Ratio prevalence.

than children who had taller fathers ($162 cm). higher odds of being stunted (95% CI (1.42–6.47))
Table 3 shows the difference of daily consumption of than those who consumed adequate dietary diversity
7 food groups among stunted and not-stunted children. (consumed $4 food groups). This study also found that
In this study, there were no differences of grains, roots minimum meal frequency was not associated with
& tubers; legumes & nuts; meat/fish/seafood; eggs; dairy stunting.
products; vitamin A rich fruits & vegetables consump- Table 5 showed the analysis of main variables of this
tions between stunted and not-stunted children (p.​ study. The result of bivariate analysis indicated that not
0.05), whereas there was difference other fruits and diverse diet was significantly associated with a higher
vegetables consumption between stunted and not- likelihood of stunting in children aged 6–23 mo (RP:
stunted children (p,​0.05). 2.87; 95%CI: 1.23–6.68). Children who consumed not
Table 4 shows the association between child feeding diverse diet were 2.87 more likely to be stunted than
indicators and stunting. This present study found that those who consumed diverse diet.
minimum dietary diversity was associated with stunt- Covariates with p-value ,0.25 were included in mul-
ing. Children who consumed inadequate dietary diver- tivariable analysis for futher analysis. Based on Table 6,
sity (consumed ,4 food groups) had a 3.03 times the results of the final multivariable model revealed that
 Poor Dietary Diversity and Stunting S403

Table 5. Association between dietary diversity and stunting in children Aged 6–23 mo.

Stunted (n541) Non-stunted (n594) Total

RP**
Dietary Diversity p
(95%CI)
f % f % f %

Not diverse 32 38.1 52 61.9 84 100 0.012* 2.87*

Diverse 9 17.6 42 82.4 51 100 (1.23–6.68)

Total 41 30.4 94 69.6 135 100

* Significant at a50,05 (p value,0,05), ** RP5Ratio prevalence.

Table 6. Multivariate analysis of logistic regression (fi- child’s age and status of breasfeeding (2). The UNICEF
nal model). recommended to feed 4 stars to meet the variety of
foods at each meal. They are animal-source foods (flesh
Variable OR (95% CI) p* meats, eggs and dairy products) 1 star; staples (grains,
roots and tubers) 2 stars; legumes and seeds 3 stars;
Dietary Diversity vitamin A rich fruits and vegetables and other fruits
Not Diverse 2.91 (1.21–7.02) 0.017
and vegetables 4 stars (8).
Diverse 1
Previous study stated that 4 of 7 food groups are
defined as a minimum dietary diversity because the cut-
* Significant at a50,05.
off is effective for predicting the adequacy of micronu-
trients and ensuring at least one of the animal source
foods (meat or eggs or milk) is consumed by child (24)
dietary diversity were the only factor associated with which have key nutrients of zinc, protein, and calcium
stunting in children aged 6–23 mo after controlling for associated with linear growth (23). A study was con-
covariates (child’s sex, mother’s education level, par- ducted by Krasevec et al (23) recommended a cutoff of
ents’ height, and child’birth weight). Children who con- five or more food groups ensures that at least one type
sumed not diverse diet were associated with a 2.91-fold of animal souces was consumed. Some studies reported
increased likelihood of stunting (relative to those who a strong association between consumption of animal
consumed diverse diet). source foods with a decreased risk of stunting (9, 24). A
study conducted in Province of Rwanda found that
DISCUSSION
although most of the children were still breastfed, their
Bivariate analysis showed minimum dietary diversity complementary diet often was low in essential nutrients
was significantly associated with stunting in children for growth and development because of a predomi-
aged 6–23 mo. This finding supported previous studies nantly plant-based diet (25).
that indicated inadequate minimum dietary diversity Stunting is a chronic malnutrition as a result of the
can increase the risk of stunting (10, 11). A previous cumulative low intake of both macronutrients and
study showed the number of food groups consumed on micronutrients and or the presence of chronic infec-
the previous day was associated with stunting. Children tions. The quality and quantity of complementary food
who consumed food from five or more food groups were can affect linear growth (5–7).
less likely to be stunted than those who consumed fewer Animal source foods are rich in macronutrients and
food groups (23). The present study also found that micronutrients that are useful for children’s growth and
minimum meal frequency was not related to stunting. development. Meat, fish and eggs are high-quality
This study examined the relation between dietary sources of protein. These foods also contain micronutri-
diversity and stunting. We found that a not diverse diet ents that are important for linear growth including
was a risk factor of stunting. In this study, dietary diver- vitamin A, vitamin B-12, riboflavin, calcium, iron and
sity was measured by considering minimum dietary zinc that are difficult to obtain in adequate quantities
diversity and minimum meal frequency which accord- from plant source foods alone (2, 7, 8). Previous studies
ing to WHO IYCF indicators. It did not only measure have shown a significant relationship between the level
quality but also quantity of complementary food that of iron and zinc adequacy with stunting in children
child consumed in the previous 3 mo before survey. The aged 6–23 mo (26, 27). A randomized controlled trial
present study found that dietary diversity was associ- study demonstarted that 1 egg per day, starting early in
ated with stunting in children aged 6–23 mo. complementary feeding from 6–9 mo and continuing
Provision of local complementary food which is pro- for 6 mo, significantly improved linear growth and
cessed in households and made from food ingredients reduced stunting (28). Iron and zinc play an essential
available in the local area is recommended considering role in bone metabolism that are required for growth
to the frequency and variation of complementary feed- and also support the immune system. Zinc plays a role
ing. The frequency of breastfeeding is adjusted to the in the production of growth hormone. It is needed to
S404 Nai HME and Renyoet BS

increase Insulin Growth Factor I (IGF I) which will complementary food. Daily consumption of food groups
accelerate bone growth (9, 27). was measured by FFQ for past 3 mo period so that it can
The present study indicated a significant difference in describe habit eating of child that related to chronic
the daily consumption of other fruits and vegetable malnutrition like stunting.
between stunted and non-stunted children. Proportion The design of this study used a cross-sectional design
of stunted children who consumed other fruits and veg- that can not prove the causal relationship. Daily con-
etables per day (17.1%) was two times lower than pro- sumption information which was obtained from respon-
portion of non-stunted children (37.2%). This different dents, has potential source of recall bias. In addition,
is thought to further strengthen the low absorption of the determination of daily consumption for each type
micronutrients. Vegetables and fruits contain many of food from each food group does not take into account
essential vitamins and minerals that are important for the weight/portion of food to be considered as food con-
health and metabolic processes in the body. Vegetables sumed in one day. The portion of food that is considered
and fruits are food sources of vitamin C, vitamin B, and “consumed” is a minimum of 15 g/d (10).
vitamin A. Consuming food sources of vitamin C along
CONCLUSION
with food sources of iron can increase the absorption of
iron in the body. In addition, vegetables and fruits con- There was a significant association between dietary
tain antioxidants which are important to counteract diversity and stunting. Poor dietary diversity is a risk
free radicals (2). The daily consumption of meat/fish factor for stunting in children aged 6–23 mo in the
and eggs in stunted children was lower than not stunted working area of ​​the Mergangsan Health Center. Com-
children, whereas daily consumption of milk products plementary feeding that consider minimum dietary di-
in stunted children is similar to not-stunted children, versity and minimum meal frequency is recommended.
although the differences of consumption were not sig- The Mergangsan Public Health Center can hold train-
nificant. ing for cadres about infant and young children feeding
In this study, dietary diversity also measured fre- practices so that they can educate mothers during
quency complementary food of children in one day. The Posyandu or home visiting. The next study can conduct
minimum meal frequency shows the quantity of com- research about dietary diversity by considering the por-
plementary feeding to meet energy adequacy in breast- tion of complementary food.
feed and non-breastfeed children aged 6–23 mo. Breast-
milk is the most hygiene food and it contains important Disclosure of state of COI
nutrients for children’s growth. However, the amount None of authors has a conflict of interest to report.
of some micronutrients in breastmilk is insufficient for
children’s growth like iron and zinc (2). Acknowledgments
Bivariate analysis showed there was association The authors would like to thank Kopertis V of Yogya-
between father’s height and stunting but in multivari- karta Region for providing research grants so that this
ate analysis there was not association after controlling research can be conducted. The Authors would like to
for main variables (dietary diversity) and other covari- thank the local authorities who permitted the data col-
ates (child’s age; education level of mother, parents’ lection In working area of Mergangsan Public Health
height, child’s birth weight). The results of bivariate Center Yogyakarta.
analysis support a study by Miko & Al-Rahmad (29) in REFERENCES
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